7/27/2016. HHVBP Sessions. General HHVBP Questions. Home Health Value Based Purchasing. Session 5: Frequently Asked Questions

Transcription

1 Home Health Value Based Purchasing Session 5: Frequently Asked Questions HHVBP Sessions Session 5: Frequently Asked Questions Previous session topics: Overview New Measures & KAHL Modules Total Performance Score and Baseline Reports Requesting Access to the Secure Portal Future session topics: Agency Specific Performance Reports 2 General HHVBP Questions What is the contact information of the Home Health Value- Based Purchasing (HHVBP) Helpdesk? The HHVBP Helpdesk can be reached by at HHVBPquestions@cms.hhs.gov). The Helpdesk number is and hours are Monday through Friday, 8:30 AM to 6:00 PM Eastern time. 3 1

2 General HHVBP Questions What payers are included in the Model? The payment adjustments in the HHVBP Model apply to only Medicare PPS claims. The measures in the HHVBP Model include the following: o OASIS-Based Measures include Medicare fee-for-service, Medicare Advantage, Medicaid fee-for-service, and Medicaid managed care o Claims-Based Measures include only Medicare fee-for-service o HHCAHPS Measures include Medicare fee-for-service, Medicare Advantage, Medicaid fee-for-service, and Medicaid managed care o New Measures Herpes Zoster (Shingles) Vaccination includes Medicare beneficiaries, including Medicare fee-for-service and Medicare Advantage (Medicare managed care) beneficiaries Advance Care Plan includes all payers 4 Can we take a photo of the patient s advance directive document in the home since they often do not have extra copies and will not let us take their copy to the office to make copies? No, per Compliance we are not allowed to photograph documents due to HIPAA concerns related to photos of anything that contains patient identifiable information. Agencies are not required to obtain a copy of the ACP. The requirement is to document in the EMR whether or not the patient has executed an advance care plan. As per guidance in 42 CFR : document in a prominent part of the individual's current medical record, or patient care record in the case of an individual in a religious nonmedical health care institution, whether or not the individual has executed an advance directive. 5 Can we collect ongoing care information and document on the Advance Care Plan/Shingles form based on a phone call with the patient or caregiver or must this be from an actual visit? Telephone conversations can be counted as a discussion with HHA staff about an advance care plan or surrogate decision maker, for the HHVBP Model measures. However, while the Advance Care Plan New Measure does not specify that the conversation must occur in person or via telephone, the regulations at 42 CFR do state that this process can occur at any time prior to providing care, including the first visit. 6 2

3 Any tips on how and when to run the Advance Care Planning/Shingles report in KL? Filters, date time frame, etc to help MCP manage these? The ACP/Shingles report is currently being reviewed for updates. In the interim we recommend using your View Online Activity workflow process and filter by the ACP/Shingles form and status. 7 The directions imply that I have to complete the Advance Care Plan/Shingles form at DC and Transfer and Home Death. Please clarify this. Yes, the form needs to be completed at transfer (both #6 and #7), at agency discharge, and death at home. It is possible that a patient has multiple transfers before discharge from the agency. Due to this recent clarification from CMS on the transfer timepoint, the ACP/Shingles Form in KL is being revised to capture data at all required time points. 8 Who can create the Advance Care Plan/Shingles form? The form can be created and assigned by proxy to a specific clinician by the MCP or QAM and the form can be created and/or updated by an RN, LPN, PT, OT, SLP, PTA, COTA, and MSW. Note: The Advance Care Plan New Measure does not specify a discipline, therefore any agency personnel could have the discussion related to the advance care plan or surrogate decision maker. Home health agencies are expected to follow their own policies and procedures that are consistent with their own State s laws in deciding who will provide information and discuss advance care planning. 9 3

4 How do we document more than one conversation during ongoing care since there is only one text box for each topic in the ONGOING CARE section of the Advance Care Plan/Shingles form? In the Ongoing Care section, below previous documentation, add the date and content of each additional discussion. 10 How do we initiate the Advance Care Plan/Shingles form for existing patients? For all current patients (already admitted), initiate a form and begin the conversation documentation in the ONGOING CARE section of the Advance Care Plan/Shingles form. 11 If the Advance Care Plan/Shingles form is not initiated at SOC, what should be done? The form is in the VBP SOC packet so it should be initiated at SOC for all new patients. If it is missed, the MCP/QAM should follow up with the admitting clinician and remind them to create the form. New Advance Care Plan/Shingles forms should be regularly initiated at SOC for all new patients and all payers during the entire VBP pilot. 12 4

5 If a patient is transferred and then has a ROC, do we complete the form at ROC in the ongoing section and then at the time of DC? Or do we pull another Advance Care Plan/Shingles form at ROC? No, ROC is not a reportable event for this measure. Any changes that may need to be documented at ROC would be included in the ONGOING CARE section of the form. 13 In regards to the Advance Care Plan/Shingles form, please confirm it is to be started on all new patients regardless of payer? Yes, the form is to be completed on all patients in the 9 HHVBP states, regardless of payer. 14 Please explain the data collection periods and data entry process for the New Measures. Data collection for all of the New Measures began on July 1, Data collection is for a full quarter, therefore, the first data collection period began on July 1, 2016 and ends on September 30, The second data collection period begins on October 1, 2016 and ends on December 31, 2016 and reporting is quarterly thereafter. Data entry into the HHVBP Secure Portal will be required to be completed by the 7th day of the month after the end of each quarter. For the first quarter of data collection, agencies will be able to enter data into the HHVBP Secure Portal from October 1, 2016 through October 7, For each quarter, agencies will be given 7 days after the end of the quarter to enter their New Measures data into the HHVBP Secure Portal. 15 5

6 What does it mean to offer the shingles vaccine? Does an agency need to actually administer the vaccine themselves in order to offer it? The New Measures Template for Herpes Zoster Vaccine, asks, How many patients were then offered the vaccine by the HHA prior to home health discharge, transfer to an inpatient facility, or death during the reporting period? In this question, offered includes agencies who offer to administer the vaccine and also agencies who offer to assist in coordinating the administration of the vaccine by another provider (e.g. the patient s physician or pharmacy). 16 What is an advance care plan and a surrogate decision maker? The Advance Care Plan provides patients with an opportunity to consider, discuss, and plan their future care with health professionals. The advance care plan measure includes patients who have an advance care plan or surrogate decision maker documented in the medical record AND also patients in which the agency has had a discussion related to an advance care plan or surrogate decision maker documented in the medical record. Advance Care Plan Document is a legal directive specifying the patient s future healthcare decisions for a time when they are not able to make their own healthcare decisions. The advance care plan document is typically referred to as an advance directive. Examples of advance care plans/advance directives include a living will, durable power of attorney for health care, Physician Orders for Life- Sustaining Treatment (POLST), Medical Orders for Life-Sustaining Treatment (MOLST), Do-Not- Resuscitate (DNR) Orders, or other legally valid documents recognized under State law. A Surrogate Decision Maker - (also known as Legal representative, Agent, Attorney in fact, Proxy, Substitute decision-maker ) is a person designated and authorized by an advance directive or State law to make a treatment decision for another person in the event the other person becomes unable to make necessary health care decisions. 17 Our agency puts information on end of life planning in our Admission Packets, can we count this as providing information on an advance care plan? No, the intent of this measure includes communication with the patient and/or their caregiver. If, in addition to providing written information, you have a conversation with the patient and/or caregiver, this would meet the requirements for providing information on advance care plan. 18 6

7 For the Staff Influenza Vaccination measure, can you please expand on the definition of "affiliation" for licensed independent practitioners? Do you mean all referring physicians? An affiliated practitioner includes: Practitioners with a contractual or legal relationship to provide services to either the agency staff or the agency patients (i.e. physician (MD, DO), advanced practice nurse, physician assistant) A physician who is not an employee of the agency, but provides services such as Medical Director, Board Member, or Clinical Consultant does not include: Clinical service contracts for agency staff (i.e. employee assistance programs or work-related injury programs) Practitioners who are ordering home health services or making referrals to the agency (if this is their only relationship with the agency) Other licensed personnel such as therapists, nurses, social workers, or dieticians/nutritionists For agencies that have contractual relationships with Accountable Care Organizations (ACOs) or that have similar contractual arrangements, physicians, advanced practice nurses, and licensed physician assistants (if making referrals is their only relationship with the agency) 19 For the Staff Influenza Vaccination measure, where do we count staff that are providing services through a contracting agency, such as contracted therapists? Data will not be collected for contracted staff providing services through a contracting agency because they are not included in the measure definition. This is not to be confused with per diem or part time staff members who are included in this measure in the employee category if they receive a direct paycheck from the agency. 20 For the Staff Influenza Vaccination measure, do we only count staff who visit patients? No. HHAs will count all employees, licensed independent practitioners, and adult students/trainees and volunteers, even if the personnel have no encounters with patients. 21 7

8 Why is it required that local branch leadership obtain Secondary Point of Contact (SPOC) access to the Secure Portal? Local branch leadership is required to access the Secure Portal to obtain Interim Performance Reports and use the New Measure Summary section to export results. 22 Is the recommendation to have two Secondary Points of Contact (SPOC) per Medicare provider number or per branch? The recommendation is to have two SPOC s by branch, not by Medicare provider number. We suggest the Branch Director of each location and one additional person per branch request SPOC access. 23 How do I unlock my EIDM account? After three unsuccessful attempts to login, your account will be locked. After 60 minutes have elapsed since your last failed attempt, your account will be unlocked. You will then be required to enter your valid login credentials and multifactor authentication to unlock the account. If unsuccessful, contact CMS XOSC Tier 1 support at or CMS_FEPS@cms.hhs.gov. 24 8

9 Why is my SSN required to register for the HHVBP Secure Portal? Identity verification is important in the process of providing sufficient information (e.g., identity history, credentials, or documents) to a service provider for the purpose of proving that a person or object is the same person or object it claims to be. Individuals requesting electronic access to CMS protected information or systems must be identity proofed prior to being given access. The social security number will be used for verification purposes only. EIDM does not share SSNs with any other federal or private agency. 25 I have registered for the HHVBP Secure Portal; however, I cannot enter it because I did not receive a security code sent to my as requested. What do I do? a) The first thing to do is check your SPAM and junk mail folders to ensure you did not receive an from NoReply@cms.hha.gov. b) Secondly, check to be sure you are using the type of Multi-factor Authentication (MFA) that you originally selected when you set up your account. For example, if you signed up for text messaging as the mode for MFA, you will receive a text message. c) Third, be sure you entered the address or phone number correctly. d) If you are still having trouble, please contact the CMS Help Desk at HHVBPquestions@cms.hhs.gov. 26 Does asking security questions for CMS registration for the HHVBP Secure Portal that are based on a person's credit report in any way at all effect his/her credit score? The credit inquiry for HHVBP registration is a soft inquiry, and therefore does not impact your credit score. 27 9

10 During the registration process my identity was not able to be verified as I do not have any credit cards and have no loans. What can I do? There is a manual process for verifying your identity if you do not have any credit cards or loan information. To complete the manual identity verification process, please contact the CMS Help Desk at HHVBPquestions@cms.hhs.gov. Note that you will need a copy of your photo ID to complete this process. 28 I incorrectly chose instead of one-time pass code in the MFA Device. How do I undo this? After you enter your user id in the EIDM Portal login process, at the bottom of the screen, you can click the link to select to register another MFA Device and it will take you through that process. 29 When and how will individuals be notified that they have been approved as Secondary Points of Contact? You will receive a system generated within two weeks notifying you that access has been granted

11 Entering Data in the Secure Portal Will the branch be responsible for manually entering the new measure data? Data entry of the new measures into the HHVBP Secure Portal has been centralized at the division level. 31 TPS and Baseline Reports Who will be making the calculations for the agency? Will this be automated? CMS will calculate the official TPS. 32 TPS and Baseline Reports Will the baseline data be individual, or based on all the other agencies in the nine states in the Model? The baseline data consists of both individual HHA level data as well as aggregate HHA data. HHAs will have access to their own quality measure data from HHAs will also have access to the Benchmark (mean of top decile of 2015 within each state and cohort) and the Achievement Threshold (median of all the HHAs in 2015 in each state and cohort). These are the reports that will be accessed through the Secure Portal

12 TPS and Baseline Reports How can I find our individual HHA baseline and performance level data? The Individual HHA baseline and performance level data will be made available beginning in the July 2016 Interim Performance Reports that will be posted on the HHVBP Secure Portal and quarterly thereafter. 34 TPS and Baseline Reports How many episodes and measures are required for a CCN to qualify for a score? According to the HHVBP scoring methodology, there must be at least 20 completed episodes for a measure to qualify for a score and at least 5 available measures to qualify for a Total Performance Score. 35 TPS and Baseline Reports When reviewing performance data, should I look at each branch separately or rolled up by provider # (CCN)? CMS is looking at the CCN roll-up data and not the individual branches

13 HHVBP Sessions Information related to VBP will be distributed via the KAH HH Value Based Purchasing distribution list HHVBP educational sessions are recorded and made available through Kindred at Home Learning Future session topics: Agency Specific Performance Reports Please your questions to the Clinical Practice and Quality Team 37 More Information CMS Home Health Value Based Purchasing Site: Contact the HHVBP Help Desk at OR Resources: HHVBP FAQ Advance Care Planning Job Aid KAH Division HH Clinical Practice & Quality Team: Judy Fenton, VP Clinical Practice and Quality; Cyndi Shook, Director Quality and Performance Improvement; Oneika Webb, Director Quality and Performance Improvement; Amy O Brien, Clinical Project Manager; Amy.OBrien@Gentiva.com Matt Janes, Director, Therapy Practice and Quality; Matt.Janes@Gentiva.com 38 13